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Pediatric inflammatory demyelinating disorders and mimickers: How to differentiate with MRI? Autoimmun Rev 2021; 20:102801. [PMID: 33727154 DOI: 10.1016/j.autrev.2021.102801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, neurodegenerative disorder of the central nervous system (CNS).While the clinical symptoms of MS most commonly manifest between 20 and 40 years of age, approximately 3 to 10% of all MS patients report that their first inaugural events can occur earlier in life, even in childhood, and thus include the pediatric population. The prevalence of MS onset in childhood/adolescence varies between 2.0% and 4.0% of all MS cases according to several extensive studies. The main imaging patterns of pediatric inflammatory demyelinating disorders and mimicking entities, including multiple sclerosis, neuromyelitis optica spectrum disorders, acute disseminated encephalomyelitis, MOG (myelin oligodendrocyte glycoprotein) antibody-related disorders and differential diagnoses will be addressed in this article, highlighting key points to the differential diagnosis.
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Padilha IG, Fonseca APA, Pettengill ALM, Fragoso DC, Pacheco FT, Nunes RH, Maia ACM, da Rocha AJ. Pediatric multiple sclerosis: from clinical basis to imaging spectrum and differential diagnosis. Pediatr Radiol 2020; 50:776-792. [PMID: 31925460 DOI: 10.1007/s00247-019-04582-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 12/20/2022]
Abstract
Pediatric multiple sclerosis (MS) deserves special attention because of its impact on cognitive function and development. Although knowledge regarding pediatric MS has rapidly increased, understanding the peculiarities of this population remains crucial for disease management. There is limited expertise about the efficacy and safety of current disease-modifying agents. Although pathophysiology is not entirely understood, some risk factors and immunological features have been described and are discussed herein. While the revised International Pediatric MS Study Group diagnostic criteria have improved the accuracy of diagnosis, the recently revised McDonald criteria also offer some new insights into the pediatric population. It is fundamental that radiologists have strong knowledge about the vast spectrum of demyelinating disorders that can occur in childhood to ensure appropriate diagnosis and provide early treatment.
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Affiliation(s)
- Igor G Padilha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil.
- Division of Neuroradiology, Diagnósticos da América AS - DASA, São Paulo, Brazil.
| | - Ana P A Fonseca
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Diagnósticos da América AS - DASA, São Paulo, Brazil
| | - Ana L M Pettengill
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Diagnósticos da América AS - DASA, São Paulo, Brazil
| | - Diego C Fragoso
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Felipe T Pacheco
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Diagnósticos da América AS - DASA, São Paulo, Brazil
| | - Renato H Nunes
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Diagnósticos da América AS - DASA, São Paulo, Brazil
| | - Antonio C M Maia
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Antônio J da Rocha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Division of Neuroradiology, Diagnósticos da América AS - DASA, São Paulo, Brazil
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Lapin WB, Lyons-Warren AM, Risen SR, Rathore N, Slone JS, Elghetany MT, Marcus M. A 14-Year-Old Boy With Fevers, Cytopenias, and Neurocognitive Decline. Pediatrics 2018; 142:peds.2017-3258. [PMID: 30072574 DOI: 10.1542/peds.2017-3258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2018] [Indexed: 11/24/2022] Open
Abstract
A 14-year-old boy presented to our institution with a 1-month history of neurocognitive decline and intermittent fevers. His history was significant for fevers, headaches, and a 10-lb weight loss. Previous examinations by multiple medical providers were significant only for bilateral cervical lymphadenopathy. Previous laboratory workup revealed leukopenia, neutropenia, and elevated inflammatory markers. Despite improvement in his laboratory values after his initial presentation, his fevers persisted, and he developed slowed and "jerky" movements, increased sleep, slurred speech, delusions, visual hallucinations, and deterioration in his school performance. A brain MRI performed at an outside hospital before admission at our institution was concerning for patchy, increased T2 and fluid-attenuated inversion recovery signal intensity in multiple areas, including the basal ganglia. After transfer to our institution and admission to the pediatric hospital medicine team, the patient had an acute decompensation. Our subspecialists will discuss the initial evaluation, workup, differential diagnosis, definitive diagnosis, and subsequent management of this patient.
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Affiliation(s)
| | | | | | - Nisha Rathore
- Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - Jeremy S Slone
- Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - M Tarek Elghetany
- Departments of Pathology and Immunology, and.,Pediatrics, Baylor College of Medicine, Houston, Texas
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Abstract
Acute disseminated encephalomyelitis is a primarily pediatric, immune-mediated disease characterized by demyelination and polyfocal neurologic symptoms that typically occur after a preceding viral infection or recent immunization. This article presents the pathophysiology, diagnostic criteria, and magnetic resonance imaging characteristics of acute disseminated encephalomyelitis. We also present evaluation and management strategies.
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